SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Go to www.irs.gov/form990 for instructions and the latest informtion.
OMB No. 1545-0047
2017
Open to Public Inspection
Name of the organization
EVANS MEMORIAL HOSPITAL INC
 
Employer identification number

58-2257925
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
 
No
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
 
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . . 		    65,908   65,908 0.530 %
b Medicaid (from Worksheet 3, column a) . . . . .     1,421,046 1,473,616    
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     1,486,954 1,473,616 65,908 0.530 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).            
f Health professions education (from Worksheet 5) . . .            
g Subsidized health services (from Worksheet 6) . . . .     616,093 310,459 305,634 2.440 %
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .            
j Total. Other Benefits . .     616,093 310,459 305,634 2.440 %
k Total. Add lines 7d and 7j .     2,103,047 1,784,075 371,542 2.970 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2017
Schedule H (Form 990) 2017
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and
training for community members		            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
3,653,431
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
1,826,716
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
3,638,968
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
3,960,193
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-321,225
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2017
Schedule H (Form 990) 2017
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 EVANS MEMORIAL HOSPITAL
200 N RIVER STREET
CLAXTON,GA304171659
WWW.EVANSMEMORIAL.ORG
054-526 		X X         X   RHC, PHYSICIAN CLINIC, PSYCH  
Schedule H (Form 990) 2017
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Schedule H (Form 990) 2017
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Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
EVANS MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 16
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a   No
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 16
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): WWW.EVANSMEMORIAL.ORG
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b   No
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2017
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Schedule H (Form 990) 2017
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Part VFacility Information (continued)

Financial Assistance Policy (FAP)
EVANS MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
HTTPS://WWW.EVANSMEMORIALHOSPITAL.ORG
b
HTTPS://WWW.EVANSMEMORIALHOSPITAL.ORG
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2017
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Schedule H (Form 990) 2017
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Part VFacility Information (continued)

Billing and Collections
EVANS MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2017
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Schedule H (Form 990) 2017
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Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
EVANS MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2017
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Schedule H (Form 990) 2017
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Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
FACILITY 1, EVANS MEMORIAL HOSPITAL - PART V, LINE 3E THE PRIORITIZATION OF SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY IS IDENTIFIED AND THE METHODOLOGY FOR PRIORITIZING EACH NEED IS DESCRIBED ON PAGE 48 OF THE 2016 CHNA.
FACILITY 1, EVANS MEMORIAL HOSPITAL - PART V, LINE 5 THE JIANN-PING HSU COLLEGE OF PUBLIC HEALTH (JHCPH) WAS COMMISSIONED BY THE GEORGIA DEPARTMENT OF COMMUNITY HEALTH, STATE OFFICE OF RURAL HEALTH (GDCH) TO CONDUCT A CHNA FOR THE HOSPITAL ORGANIZATION. THE PROJECT TEAM, WHICH CONSISTED OF 16 INDIVIDUALS FROM JHCPH AND GDCH, WORKED WITH HOSPITAL LEADERSHIP AND THE COMMUNITY ADVISORY BOARD (CAB) TO RECRUIT COMMUNITY MEMBERS FOR FOUR FOCUS GROUPS, WITH AN AVERAGE OF SEVEN PARTICIPANTS IN EACH FOCUS GROUP. ONE FOCUS GROUP WAS CONDUCTED WITH MEMBERS OF THE CAB, WHILE THE REMAINING FOCUS GROUPS INCLUDED RESIDENTS OF THE COMMUNITY, BUSINESS LEADERS, AND HOSPITAL LEADERSHIP. SIX FOCUS GROUPS WERE HELD, WITH AN AVERAGE OF 11 PARTICIPANTS IN EACH FOCUS GROUP. CATEGORIES OF GROUPS WERE AS FOLLOWS: 1) STEERING COMMITTEE (INDIVIDUALS WHO WERE EMPLOYED BY THE HOSPITAL OR WHO WERE HIGHLY KNOWLEDGEABLE OF THE HOSPITALS FINANCIAL SITUATION); 2) COMMUNITY ADVISORY MEMBERS (INDIVIDUALS FROM THE COMMUNITY WHO CURRENTLY PARTNERED WITH THE HOSPITAL); 3) BUSINESS LEADERS WITHIN THE COMMUNITY; AND 4) LAY COMMUNITY MEMBERS. THE SIX GROUPS WERE RECRUITED BY HOSPITAL LEADERSHIP. FINDINGS FROM THE FOCUS GROUPS WERE USED TO DEVELOP A COMMUNITY SURVEY AIMED AT ASSESSING LOCAL HEALTH CARE ACCESS AND OTHER NEEDS CRITICAL FOR THE STABILIZATION OF THE LOCAL RURAL COMMUNITY HOSPITAL. THE COMMUNITY SURVEY WAS MAILED TO A 20% RANDOM ADDRESS-BASED SAMPLE OF RESIDENTS (N=1,538) LIVING IN THE HOSPITALS PRIMARY SERVICE AREA (TOP TWO PATIENT ZIP CODES).
FACILITY 1, EVANS MEMORIAL HOSPITAL - PART V, LINE 6B THE ORGANIZATION CONDUCTED ITS 2016 CHNA PARTNERING WITH JIANN-PING HSU COLLEGE OF PUBLIC HEALTH.
FACILITY 1, EVANS MEMORIAL HOSPITAL - PART V, LINE 11 THE 2016 CHNA IDENTIFIED THE FOLLOWING COMMUNITY ISSUES WHICH THE HOSPITAL ORGANIZATION HAS INCLUDED IN ITS IMPLEMENTATION STRATEGY PLAN: 1. NEED FOR HOSPITAL COMMUNITY OUTREACH, HEALTH PROMOTION, AND EDUCATION TO ADDRESS CHRONIC DISEASE CONDITIONS AND OTHER HEALTH ISSUES 2. HEALTH CARE ACCESS 3. MENTAL HEALTH AND BEHAVIORAL HEALTH ISSUES THE HOSPITAL FEELS THAT CERTAIN ISSUES WERE BEYOND THEIR SCOPE OF HEALTHCARE, OR A LACK OF RESOURCES PREVENT ADEQUATE ATTENTION TO BE FOCUSED IN THOSE AREAS, OR THAT OTHER COMMUNITY PROVIDERS WERE BETTER SUITED TO ADDRESS THEM. ISSUES IDENTIFIED BUT NOT PURSUED BY THE HOSPITAL INCLUDE: 1. ECONOMIC DEVELOPMENT (LACK OF INDUSTRY, UNEMPLOYMENT, POVERTY) 2. SOCIAL HEALTH ISSUES (LOW EDUCATIONAL ATTAINMENT, TEENAGE PREGNANCY, STI PREVALENCE, LACK OF SOCIAL AMENITIES) 3. LOW UTILIZATION OF PREVENTATIVE SERVICES THE 2016 CHNA AND IMPLEMENTATION STRATEGY CAN BE FOUND ON THE ORGANIZATION'S WEBSITE AT: HTTP://WWW.EVANSMEMORIALHOSPITAL.ORG/ASSETS/EVANS_CHNA_FINAL_DOCUMENT_2017. PDF
FACILITY 1, EVANS MEMORIAL HOSPITAL - PART V, LINE 20A IN THE EVENT OF NON-PAYMENT BY A PATIENT FOR THEIR PORTION OF THEIR ACCOUNT, EMH OR ITS REPRESENTATIVE WILL SEND TWO COLLECTION LETTERS BEFORE SENDING THE ACCOUNT TO A COLLECTION AGENCY.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2017
Page 9
Schedule H (Form 990) 2017
Page 9
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?3
Name and address Type of Facility (describe)
1 EVANS FAMILY CENTERED HEALTHCARE
501 E LONG STREET
CLAXTON,GA304171435 		RURAL HEALTH CLINIC
2 SURGICAL ASSOCIATES
604A EAST LONG STREET
CLAXTON,GA304175914 		PHYSICIAN CLINIC
3 EVANS MEMORIAL INPATIENT PSYCH UNIT
200 NORTH RIVER ST
CLAXTON,GA30417 		PSYCHIATRIC UNIT
4
5
6
7
8
9
10
Schedule H (Form 990) 2017
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Schedule H (Form 990) 2017
Page 10
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
PART I, LINE 7G - SUBSIDIZED HEALTH SERVICES EXPLANATION THE PHYSICIAN CLINIC OPERATES IN A MEDICALLY UNDERSERVED AREA RENDERING A TOTAL SUBSIDIZED LOSS OF 305,634.
PART I, LINE 7, COLUMN (F) - EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE IN DERIVING THE DENOMINATOR TO BE USED FOR COLUMN (F), THE FOLLOWING ADJUSTMENTS WERE MADE TO THE TOTAL EXPENSES REPORTED ON FORM 990, PART IX, LINE 25: FORM 990, PART IX, LINE 25 12,503,123 ADD: NET EXPENSES IN PART VIII 17,838 DENOMINATOR FOR COLUMN (F) 12,520,961
PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION THE AMOUNTS REPORTED ON LINE 7A AND 7B ARE REPORTED AS INSTRUCTED BY CATHOLIC HEALTH ASSOCIATION'S "A GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFITS, 2008". OTHER COSTS WERE OBTAINED FROM THE ORGANIZATION'S FINANCIAL RECORDS.
PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY AMOUNTS INCLUDED ON PART III LINE 2 REPRESENT THE AMOUNT OF CHARGES CONSIDERED UNCOLLECTIBLE AFTER REASONABLE ATTEMPTS TO COLLECT, AND WRITTEN OFF TO BAD DEBT EXPENSE.
PART III, LINE 3 BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCE THE FIGURE ON PART III LINE 3 REPRESENTS MANAGEMENT'S ESTIMATE (APPROXIMATELY 50%) BASED ON AN ANALYSIS OF SELF PAY PATIENTS' ABILITY TO PAY THEIR OUTSTANDING ACCOUNT. THIS ANALYSIS INCLUDES REVIEWING THE PATIENT'S CREDIT HISTORY, INCOME LEVELS AND OVERALL COLLECTIBILITY OF THE ACCOUNT AS WELL AS INCOMPLETE APPLICATIONS FOR FINANCIAL ASSISTANCE.
BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS SEE THE ATTACHED AUDITED FINANCIAL STATEMENTS PAGE 10 FOR THE FOOTNOTE ON ALLOWANCE FOR DOUBTFUL ACCOUNTS.
PART III, LINE 8 - MEDICARE EXPLANATION MEDICARE ALLOWABLE COSTS ARE COMPUTED IN ACCORDANCE WITH COST REPORTING METHODOLOGIES UTILIZED ON THE MEDICARE COST REPORT AND IN ACCORDANCE WITH RELATED REGULATIONS. INDIRECT COSTS ARE ALLOCATED TO DIRECT SERVICE AREAS USING THE MOST APPROPRIATE STATISTICAL BASIS.
PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION THE HOSPITAL WRITES OFF PATIENT BALANCES FOR PATIENTS QUALIFYING FOR CHARITY CARE OR FINANCIAL ASSISTANCE AND DOES NOT MAKE FURTHER COLLECTION EFFORTS. PATIENT FINANCIAL COUNSELORS VISIT PATIENTS WHO HAVE NO INSURANCE, LIMITED COVERAGE AND MEDICAID PATIENTS WITHOUT SUPPLEMENTAL INSURANCE TO DISCUSS ASSISTANCE AND REFER THOSE PATIENTS TO OUR MEDICAID ELIGIBILITY VENDOR WHO SCREENS THESE PATIENTS FOR MEDICAID AND OTHER FEDERAL, STATE OR LOCAL PROGRAMS FOR ASSISTANCE. CUSTOMER SERVICE AT THE HOSPITAL AND AT EXTENDED BUSINESS OFFICE WHICH DOES SELF-PAY BILLING AND COLLECTION, INFORMS PATIENTS ABOUT OUR FINANCIAL ASSISTANCE PROGRAM AND ASSISTS THEM IN MAKING AN APPLICATION. BILLING STATEMENTS PROVIDE A MESSAGE AND TELEPHONE NUMBER TO CALL IF THE PATIENT HAS DIFFICULTY MAKING PAYMENT. FOR PATIENTS WHO QUALIFY FOR CHARITY CARE AND FULL FINANCIAL ASSISTANCE, THERE IS NO FINANCIAL OBLIGATION. FOR THOSE WHO QUALIFY FOR PARTIAL FINANCIAL ASSISTANCE, COLLECTIONS PROCEDURES FOLLOW THE SAME PROCESS AS ALL OTHER PATIENTS WHO ARE RESPONSIBLE FOR UNPAID BALANCES. THOSE PATIENTS WHO HAVE NOT MADE PAYMENT ARRANGEMENTS FOR THEIR REMAINING BALANCES ARE SENT LETTERS WHERE THEY ARE PAST DUE 30, 60 AND 90 DAYS. IF PAYMENT ARRANGEMENTS ARE STILL NOT MADE AFTER 90 DAYS, THEN THOSE ACCOUNTS ARE REFERRED TO COLLECTIONS.
PART VI, LINE 2 - NEEDS ASSESSMENT A COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED DURING FISCAL YEAR 2016. IN ADDITION, THE ORGANIZATION CONTINUALLY CONDUCTS VARIOUS TYPES OF ASSESSMENTS TO DETERMINE THE COMMUNITYS NEEDS FOR HEALTH AND PERSONAL SUPPORT SERVICES. OUR ORGANIZATION COLLABORATES WITH NUMEROUS NOT-FOR- PROFIT AGENCIES AND PROGRAMS TO EXTEND AND STRENGTHEN OUR MISSION. OUR PROGRAMS ARE SUCCESSFUL DUE IN LARGE PART BECAUSE OF THESE COLLABORATIONS. ONE EXAMPLE OF THIS IS EVANS COUNTY CARES. MANY OF OUR ORGANIZATION CO- WORKERS ARE ALSO INVOLVED AT EVERY LEVEL OF THE COMMUNITY THROUGH THEIR WORK AS ORGANIZATION REPRESENTATIVES ON NOT-FOR-PROFIT BOARDS. WITH OUR PARTNERS, WE LISTEN TO OUR PATIENTS AND CLIENTS AS WELL AS ACCESS EXISTING NEEDS ASSESSMENTS AND STUDIES IN ORDER TO DETERMINE THE COMMUNITYS MOST PRESSING NEEDS. THE ORGANIZATION USES FEDERAL INFORMATION AND REPORTS FROM AGENCIES SUCH AS THE U.S. CENSUS BUREAU AND BUREAU OF LABOR STATISTICS AS WELL AS RESOURCES SUCH AS DEMOGRAPHICS NOW THAT PROVIDE A WIDE ARRAY OF DEMOGRAPHICS, HOUSEHOLD INCOME AND SERVICES, RETAIL OUTLETS, ETC. IN DEFINED ZIP CODES. THIS INFORMATION, COMBINED WITH OUR EXTENSIVE COLLABORATIONS AND OUR ROLE AS A LEADER IN THE COMMUNITY, PROVIDES US THE MEANS TO UNDERSTAND AND ADDRESS THE COMMUNITYS NEEDS AND ENSURES OUR OUTREACH PROGRAMS ARE FOCUSED ON THE POPULATIONS WHO NEED OUR SERVICES THE MOST.
PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE CUSTOMER SERVICE PERSONNEL AT THE HOSPITALS AND THE ORGANIZATIONS EXTENDED BUSINESS OFFICE INFORMS PATIENTS ABOUT OUR FINANCIAL ASSISTANCE PROGRAM AND ASSISTS THEM IN MAKING AN APPLICATION. FOR PATIENTS WHO HAVE NO INSURANCE, LIMITED COVERAGE AND MEDICAID PATIENTS WITHOUT SUPPLEMENTAL INSURANCE, PATIENT FINANCIAL COUNSELORS DISCUSS THE FINANCIAL ASSISTANCE AND VARIOUS GOVERNMENT BENEFITS WHICH MAY BE AVAILABLE TO THEM. PATIENT FINANCIAL COUNSELORS ALSO REFER APPROPRIATE PATIENTS TO A MEDICAID ELIGIBILITY VENDOR WHO SCREENS THEM FOR MEDICAID AND OTHER FEDERAL, STATE OR LOCAL PROGRAMS FOR ASSISTANCE. THE ORGANIZATION POSTS FINANCIAL ASSISTANCE INFORMATION AT ITS REGISTRATION AREAS. IN ADDITION, THE BILLING STATEMENTS SENT TO PATIENTS PROVIDE A MESSAGE AND FINANCIAL ASSISTANCE CONTACT INFORMATION IN THE EVENT THE PATIENT HAS DIFFICULTY PAYING THE BALANCE DUE.
PART VI, LINE 4 - COMMUNITY INFORMATION THE ORGANIZATION SERVES A PREDOMINATELY RURAL AREA IN SOUTHEAST GEORGIA. THE PRIMARY SERVICE AREA CONSISTS OF EVANS AND TATTNALL COUNTIES. THE CITY OF CLAXTON IS THE ECONOMIC HUB FOR THE REGION, AND THE ORGANIZATION DRAWS FROM A POPULATION OF APPROXIMATELY 32,000 RESIDENTS FOR HEALTH CARE SERVICES. THE REGION IS MARKED BY VAST DICHOTOMIES OF WEALTH, EDUCATION AND HEALTH STATUS. THE ORGANIZATION SERVES A POPULATION THAT HAS A HIGH PROPORTION OF LOW-INCOME INDIVIDUALS. MAJOR HEALTH ISSUES ARE DIABETES, OBESITY, AND HEART DISEASE.
PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH ALL OF THE ORGANIZATIONS HEALTHCARE FACILITIES, INCLUDING ITS HOSPITAL, FURTHER THEIR EXEMPT PURPOSES BY PROMOTING THE HEALTH IN OUR COMMUNITY IN A VARIETY OF WAYS AS WELL AS THOSE ALREADY DESCRIBED. THE GOVERNING BODIES OF ALL OF OUR ORGANIZATIONS ARE PRIMARILY COMPRISED OF PERSONS WHO ARE NOT EMPLOYEES, CONTRACTORS (NOR FAMILY MEMBERS THEREOF), AND WHO RESIDE IN THE ORGANIZATIONS PRIMARY SERVICE AREA. THE HOSPITAL'S MEDICAL STAFFS ARE OPEN TO ALL QUALIFIED PHYSICIANS IN THE REGION. FOR THOSE PHYSICIANS IN THE REGION WHO DO NOT HAVE PRIVILEGES, THE ORGANIZATION PROVIDES A PROCESS FOR ADMITTING PATIENTS VIA THE HOSPITALISTS OR THROUGH OTHER PHYSICIANS. FUNDS RECEIVED FROM THE OPERATIONS OF THE ORGANIZATION HOSPITAL AND FACILITIES (AFTER OPERATING EXPENSES) ARE USED TO SUPPORT VARIOUS OUTREACH EFFORTS AND ALLOWS PATIENTS TO RECEIVE HIGH QUALITY CARE IN THEIR OWN COMMUNITY. IT ALSO ALLOWS US TO CONTINUALLY IMPROVE PATIENT SAFETY BY IMPLEMENTING TECHNOLOGY THAT PREVENTS MEDICATION ERRORS, ETC.
PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM EVANS MEMORIAL HOSPITAL, INC. IS A VITAL PART OF AN AFFILIATED HEALTH CARE SYSTEM THAT INCLUDES EVANS MEMORIAL FOUNDATION, INC. AND EVANS MEMORIAL HEALTH ORGANIZATION, INC. EVANS MEMORIAL HOSPITAL, INC. MANAGES AND OPERATES EVANS MEMORIAL HOSPITAL, A 49 BED ACUTE CARE NOT-FOR-PROFIT HOSPITAL, A RURAL HEALTH CLINIC, AN INPATIENT PYSCHIATRIC UNIT, AND A PHYSICIAN'S OFFICE. EVANS MEMORIAL FOUNDATION, INC. WAS ESTABLISHED TO RAISE FUNDS OF ANY KIND OR CHARACTER TO BE USED EXCLUSIVELY FOR CHARITABLE, MEDICAL EDUCATION, AND SCIENTIFIC PURPOSES AT OR IN CONNECTION WITH EVANS MEMORIAL HOSPITAL, INC. EVANS MEMORIAL HEALTH ORGANIZATION, INC. WAS ORGANIZED TO SUPPORT, PROMOTE, ADVANCE AND STRENGTHEN EVANS MEMORIAL HOSPITAL, INC. AND OTHER NONPROFIT HEALTH CARE PROVIDERS ORGANIZED FOR CHARITABLE AND CIVIC PURPOSES. ADDITIONALLY, THE ENTITY MAY PARTICIPATE IN, FORM, OWN AND OPERATE JOINT VENTURES, PARTNERSHIPS, CORPORATIONS OR OTHER ENTITIES IN FURTHERANCE OF THE CHARITABLE, EDUCATIONAL AND SCIENTIFIC PURPOSES FOR WHICH THE CORPORATION IS ORGANIZED.
PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT GEORGIA
Schedule H (Form 990) 2017
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